The relationship between breastfeeding and depression is complex. According to the Centers for Disease Control and Prevention (CDC), 81.1 percent of women will initiate breastfeeding right after giving birth, but many will stop before their child reaches the age of one. There are even studies that suggest women who stop breastfeeding early have higher rates of postpartum depression.
The Relationship Between Breastfeeding and Depression
According to the American Congress of Obstetricians and Gynecologist 1 in 7 women will experience depression after giving birth. This distressing diagnosis may greatly impact their breastfeeding experience.
The Breastfeeding Experience
There are experts that argue it is the breastfeeding experience rather than the length of time a woman is able to breastfeed that is a better indicator of postpartum depression. Women who stopped breastfeeding because of pain, infection, or physical difficulties such as reduced milk supply or exhaustion were at greater risk for developing depressive symptoms.
How Depression Affects Breastfeeding
Women who terminate breastfeeding early may experience higher rates of depression. Results from a 2011 study found women who attempted and failed at breastfeeding had higher rates postpartum depressive symptoms. Similarly, women who were not successful in initiating breastfeeding were almost 2.5 times more likely to develop depression symptoms four months after giving birth as compared to women who were able to breastfeed successfully.
How Breastfeeding Affects Depression
Women who are able to breastfeed successfully are less likely to experience depressive symptoms after giving birth. A British study found women had a lower risk of postpartum depression after delivery if they intended to breastfeed and were successful at initiating lactation. Similar results were noted in the May 2015 Journal of the Academy of Pediatrics, where researchers discovered depressive symptoms were lower among women meeting their expectation to breastfeed exclusively versus those who did not.
Who Is at Risk?
All women regardless of age, race, or socioeconomic status are at risk for postpartum depression while breastfeeding. Although it is impossible to predict who will develop symptoms of postpartum depression, there are certain physiological, psychological and sociocultural factors that make some women at higher risk.
Women With a History of Depression
The American Congress of Obstetricians and Gynecologists note women who have experienced depression before pregnancy have a greater chance of developing depression after pregnancy. Since depression peaks in women during their reproductive years, it may be no surprise that major and minor depressive episodes happening during pregnancy and one year after delivery are the most common medical problems most women face during the postpartum period.
Women With Less Social Support
Social relationships help develop self-worth, psychological well-being, and access to resources during stressful periods. Pregnancy, a time of significant change, may necessitate the need for more support. Women with less social support have higher rates of depression whether they are breastfeeding or not. In 2012, researchers found women with fewer positive social interactions had a higher chance of becoming depressed after giving birth.
Women Experiencing Unintended Pregnancy
Not every pregnancy is desired or well-timed, which may be an additional life stressor. Evidence suggests women with unintended pregnancies are more likely to experience depression after giving birth as compared to women with planned pregnancies, regardless of breastfeeding status. This finding was more pronounced among women who reported negative or ambivalent feelings in early in their pregnancy. A study of Asian women found women with negative attitudes towards their current pregnancy were twice as likely to develop depression after birth.
Treating Depression While Nursing
If you take an antidepressant, your depressive symptoms generally improve with their continued use. Many nursing mothers are afraid to use antidepressants while breastfeeding because of their fear of passing the medication through their breast milk. Antidepressants can transfer to the infant during breastfeeding, but the levels found in breast milk generally are very low.
Various antidepressants may be used with breastfeeding women.
- Many women are started on a serotonin reuptake inhibitor (SSRI) treatment because they are easy to use and have low toxicity levels. Women who respond favorably to an initial trial of medication may be continued on the same dose for at least 6 months even after symptoms disappear.
- There are, however, certain SSRIs, such as Prozac and Celexa, that have higher levels of concentration in breast milk. Women who want to breastfeed and continue using these drugs should speak with their healthcare professional to learn about the associated risks.
- Women who experience side effects while taking any antidepressant should schedule an appointment with their healthcare provider as soon as possible.
Antidepressants are used most often to treat postpartum depression. Hormonal therapy and psychotherapy are, however, alternative therapies that can be used for treatment.
- Hormonal treatments: Women experience dramatic changes in hormones after giving birth. Studies have indicated women with postpartum depression benefitted from sublingual estrogen treatment even only after 2 weeks of treatment. Similar findings were seen in women who used estrogen patches every day. These women experienced fewer depressive symptoms after one month of treatment, and these benefits continued for 6 months. Only trace amounts of estrogen are passed into breast milk for doses up to 100 mcg. Women may experience a decrease in milk supply if their treatment is started before their lactation is well-established, which typically occurs 6 to 8 weeks postpartum. Discontinuing the treatment can often restore milk production.
- Psychotherapy: Having someone to speak with when you are feeling lonely and isolated or misunderstood can help you overcome personal difficulties. Psychotherapy is usually presented as an alternative to prescription therapy or in addition to antidepressant drug therapy. Individual psychotherapy sessions presented by either experienced psychotherapists, trained health visitors, or both were effective in treating depression after birth, including in breastfeeding mothers. Similarly, findings indicate that a greater proportion of women who received interpersonal psychotherapy had a reduction in symptoms as compared to women who did not receive any therapy.
What Is Postpartum Depression?
Postpartum depression (PPD) generally happens right after having a baby. Symptoms during the postnatal period are usually more intense and last longer than symptoms of "baby blues."
Postpartum depression symptoms are similar to those of major depression but may also include:
- Crying more often than usual
- Feelings of anger
- Withdrawing from loved ones
- Extreme worry about your baby or feeling distant from your baby
- Worrying that you will hurt your baby
- Feeling guilty about not being a good parent or doubting your ability to care for your baby
While postnatal depression may be brief with symptoms ending unexpectedly, about 30 percent of women will continue to be depressed up to two years after giving birth.
What to Do if You Are Depressed
If you have experienced emotional changes or think you may be depressed, make an appointment to talk to your healthcare provider as soon as possible.
- Don't wait until your postpartum checkup to start this conversation but instead schedule an appointment right away.
- If you are in a state of crisis, tell someone who can help immediately, call 9-1-1 or go to the nearest hospital emergency department for medical treatment.
- If you have a history of depression or are taking an antidepressant, tell your healthcare provider early in your prenatal care. Your provider may start you on treatment right after delivery to prevent postpartum depression.
- If you are taking antidepressants before pregnancy, speak with your healthcare provider to best assess your situation and help you decide whether to continue taking medication during your pregnancy.
Help is always available by phone or online when you are feeling overwhelmed. These resources can provide useful information about breastfeeding and depression resources near you so you don't have to go through this tough time alone.
Help by Phone
The National Suicide Prevention Lifeline provides support for individuals in distress. This free and confidential a hotline is available 24 hours a day, 7 days a week. The online chat feature is also available 24 hours a day every day of the week.
There is also help available online.
- The Office on Women's Health offers resources on postpartum depression and links to other postpartum depression publications and websites.
- Moms' Mental Health Matters offers printed and online materials about to depression and anxiety during pregnancy and after birth.
- Postpartum Support International aims to increase awareness about the emotional changes that women experience during and after pregnancy. The site offers resources and information on perinatal mental health.
- La Leche League International provides mothers around the world with information and education to promote a better understanding of breastfeeding. The site provides a number of resources including local personal support, podcasts, and online forums.
Depression outcomes can be detrimental to the breastfeeding experience for mothers and infant. Recognizing the risk factors, symptoms of depression, and seeking help early can facilitate steps towards improved self-care and restored health.